Content » Vol 52, Issue 8

Original report

Symptoms of adjustment disorder and smoking predict long-term functional outcome after ankle and lower leg fracture

Sabine Weimert, Sebastian Kuhn, Pol M. Rommens, Manfred E. Beutel, Iris C. Reiner
Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg University Mainz, 55131 Mainz, Germany. E-mail:
DOI: 10.2340/16501977-2701


Objective: To examine the psychological, social, behavioural and injury-related factors impacting functional outcome in patients with ankle or lower limb fracture one year post-operation.
Methods: In this prospective study 66 patients with ankle or lower leg fracture were recruited and followed up one year post-operation. Possible associations between predictors and functional outcome were explored by regression analyses. Functional outcome was assessed with the American Orthopedic Foot and Ankle Society Ankle-Hindfoot Score.
Results: Linear regression models revealed that smoking and elevated symptoms of adjustment disorder were associated with lower functional outcome one year post-operation. Fracture type, depressive symptoms and quality of relationship had no effect on functional outcome. A second linear regression revealed that preoccupations were correlated with functional outcome.
Conclusion: Smoking and symptoms of adjustment disorder, specifically preoccupations, are associated with functional outcome one year post-operation in patients recovering from ankle or lower leg fractures. The results support the notion that differences in functional recovery are attributable to psychological and behavioural factors rather than to fracture type. Psychological, fracture-specific, symptoms play a role in functional recovery rather than general affective symptoms.

Lay Abstract

After ankle and lower leg fractures, some patients remain impaired for up to one year. Psychosocial factors are known to influence recovery after orthopaedic trauma. This long-term study examined how psychosocial, behavioural and injury-related factors are associated with functional outcome one year after injury. The results show that patients who smoke at 4 weeks after the fracture and have increased symptoms of adjustment disorder have a poorer outcome one year after injury. Fracture type, social support in the relationship and depressive symptoms are not associated with outcome one year after the fracture.

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